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FIGHTING INSURANCE AND FINANCIAL FRAUD MORE EFFECTIVELY THAN EVER BEFORE
Introducing Nemesysco’s RA7
About Nemesysco
One technology, numerous uses:
RA7 solution - overview
RA7 solution - overview
• 1 integrated solution• 1 day agent’s or 5 days front line investigator training!
• 100 % calls coverage• Streamline & standardize investigation procedures
• Unbiased. Informing. Precise.
RA7 solution
RA7 can be used for:• Claim processing• Underwriting & Risk assessment
• Loan requests & credit cards• Periodic “over-the-phone” tests
RA7 solution - Limitations
•Not all fraud will be detected.•Not all cases will be proved.•Not all customers will be happy.
… but most of the time it will.
RA7 solution – Limitations explained…
RA7 solution – Limitations explained…
(1)To have a significant effect on your bottom line.
(2)To improve customer service
(3)To change as little as possible current procedures
RA7 – Our mission:
RA7 – Our mission:
• Using RA7 solution we will achieve the following:• Monitor all incoming claim calls for fraud attempts
increase overall Fraud Detection Rate
• Add 2nd level of customer handling
“Assist” fraudsters withdraw their claims
• Provide a faster payout for claims that are risk-free
Faster and better service for legitimate customers
• Customer awareness to the “Risk” taken when trying to commit fraud
reduce number of fraudulent claims
RA7 solution – One System
• The contact center – Today:• No procedure for risk assessment, no point in training• The only place in touch with 100% of the calls
• Claim Managers / Loss adjustors• Oversees all cases, must reach decisions fast• Lacking tools to really detect fraud –tools are biased by definition
• Investigators• Limited and expensive resources• Poor start point with little useful data• Have to filter through high % of genuine claims
Streamlined process
5-10 Minutes
1 - 5 Minutes
Fast -track payment
FormalInvestigation
30 minutes (adjusting the claim)
Streamlined process
• 100% of the calls are monitored and analyzed• Operators follow a special “conversation script”• RA7 automatically determines RISK LEVEL for each of the calls• Trained operators can detect and deter fraud at the initial
interaction
Streamlined process
• Claim managers / Loss adjustors receive clear reports of all claims
• Easily manage and assign high-risk cases to investigation• Can conduct a follow-up interview or authorize the payment
Streamlined process
• Handle only high risk claims – better chance for defeat• Save time on the field - conduct more phone investigations• Can use other professional tools by Nemesysco
Fraud awareness,a real necessity…
A survey conducted in Pennsylvania in 2008 revealed the following:1.Knowledge about insurance fraud itself is minimal. Only one in six
respondents was knowledgeable about how insurance fraud is classified and defined. Even fewer understand that insurance fraud is a felony.
2.Many do not believe insurance fraud is a serious crime. Only 12% categorized insurance fraud as one of the most serious types of crimes and only 25% said they were likely to report someone who was committing it.
3.Nearly 70% stated strongly they would never consider committing insurance fraud. But, this leaves 30% who might consider committing the crime.
4.Almost all surveyed believe that insurance fraud perpetrators rarely get caught. An extremely low number (3%) reported “strongly believing” those who commit insurance fraud will be discovered and apprehended.
RA7 project process
• Adopting the new concept & technology• The “fraud prevention stick” and “Fast track carrot”• Becoming proactive in fraud detection• P.R. and Legal concerns
• Creating scripts• Understand in-house investigators needs• Covering all types of relevant claims
• Implementing RA7• IT and installation• Training & Mentoring• Follow-up and support
WE LOOK FORWARD SERVING YOU TOO!